Trigger Point Dry Needling (T.D.N.)

T.D.N. is an effective therapy to treat muscular tension and spasm which commonly accompanies conditions such as arthritis, nerve irritation, muscular strain, ligament strains and herniated discs. It is called “Dry” Needling because there is no solution injected as with a hypodermic needle during a flu shot. With Dry Needling, the needle itself and the effects it produces within the tissue is the treatment.

When an injury occurs from repetitive use or acute trauma, inflammation will be produced from the damaged tissues. The damaged tissues will also go into a protective tension state or contracture to guard against further damage from utilizing the injured tissue. This contracture and inflammation inhibit microcirculation which limits both the oxygen rich blood reaching the injury and the waste products leaving the injury. The injury site becomes hypoxic (decreased in oxygen) which stimulates the body to produce fibroblasts, a cell that produces fibrosis or scar tissue. This fibrosis and scarring builds up around the muscles and tissues limiting the tissues ability to fully function (lengthen/shorten) and can also cause compression and irritation of nerves (such as carpal tunnel syndrome) – all of which inevitably lead to biomechanical disturbances in gait and function.

T.D.N. uses a small, solid filament needle which is inserted in a contracted painful knotted muscle to create a local twitch reflex which is both diagnostic and therapeutic as it is the first step in breaking the pain cycle as research shows will decrease muscle contraction, reduce chemical irritation, improve flexibility and decrease pain. When a needle is inserted into muscle it will also produce a controlled lesion and will cut between three to fifteen thousand individual muscle fibers. The body considers the needle as a foreign invader and will activate the immune system as a response. The cut muscle fibers also produce an inflammatory reaction that your body will respond to not just locally but all over the body to reduce inflammation systemically.

Mechanical effects

Dry Needling may mechanically disrupt a dysfunctional motor end plate

Needling results in a Local Twitch Response (LTR)

The LTR results in an alteration to muscle fiber length as well as having an inhibitory effect on antagonistic muscles

Another possible mechanism of dry needling is the activation of descending inhibitory systems which would block noxious stimulus into the dorsal horn

The LTR may also utilize the excessive ACh in the tissue which previously was triggering increased firing of localized fibers

Chemical effects

Studies by Shah and colleagues (2001) demonstrated increased levels of various chemicals at sensitized motor end plates such as: Bradykinin, Substance P and CGRP (regulator of Calcium and Phosphate balance). These chemicals were reduced immediately post a LTR

CGRP enhances the release of ACh from nerve terminals, which results in increased ACh receptors at the neuromuscular junction

Needle penetration will cause micro-trauma and micro bleeding (localized inflammation) and hence the introduction of PDGF into the area to help promote healing

Is Trigger Point Dry Needling Acupuncture?

No, Trigger Point Dry Needling is based on Western medical research and principles, whereas acupuncture is based on Traditional Chinese Medicine.

What Types of Conditions Can TDN Assist?

Neck/Back Pain

Shoulder Pain

Tennis/Golfers Elbow

Headaches

Hip and Gluteal Pain

Knee Pain

Achilles Tendonitis/Tendonosis

Plantar Fasciitis

Sciatica

Muscular Strains/Ligament Sprains

Chronic Pain

Athletic Performance

Does TDN hurt?

You may or may not feel the insertion of the needle. The specific needle manipulation is intended to produce a local twitch response that can elicit a very brief (less than a second) painful response some patients describe as a deep ache or cramping sensation. Again, the therapeutic response occurs with the elicitation of the local twitch response and is a desirable reaction.

What can I do to prepare for my therapy?

Eat a light meal 1-2 hours prior to your visit and wear loose, comfortable clothing that can be rolled up or down to access your areas of concern with the greatest ease.

What can I expect after treatment?

We are looking to get improvements even from the first visit such as increased range of motion, ease of movement and decreased signs/symptoms.

Many patients report being sore after the treatment in both the area treated and the area of referred symptoms. Typically this soreness lasts between a few hours and two days and there is occasional bruising. Soreness may be alleviated by applying ice or heat to the area and performing specific stretches for the treated muscle.

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